Are you seeking mentoring/coaching for...
All the above
What is your definition of a mentor/coach?
Do you think there is a difference between a mentor and a coach and if so, please explain.
Why are you seeking a mentor/coach at this time?
Have you ever received professional coaching in the past?
What do you want/need to be mentored in? For example, what goals do you want to achieve? What information do you want to gain access to?
What time commitment are you looking for from your Mentor?
What specific questions need to be answered?
What specific objectives and experiences do you think will help you achieve your goals?
What kind of time commitment are you willing to make to a mentoring relationship? How formal? Frequency of meeting?Length of relationship?
What do you think you can offer to a mentor who is willing and able to work with you?
For each item below, put a check in the “yes” column if the reason listed reflects why mentoring appeals to you. If it does not, put a check in the “no” column. Following each item, list concrete examples to illustrate your answer
Shares the tacit and technical knowledge of the professional field, the environment, and the institutional social and political culture and climate
Demonstrates accepted and valued behaviors and attitudes within the profession and institution
Supports, sponsors and stimulates you in terms of professional advancement
Uses connections to promote and create opportunities
Assists in identifying and clarifying your needs and goals
Prepares you for professional growth inside and outside the organization
Provides advice, assistance and guidance on a more personal level
Nurtures and reinforces your identity, including self‐confidence and self image
Models the personality traits, skills and/or knowledge that you admire
Assists in planning for the future and determining ways or methods of achieving desired goals
Assists in searching for new ways to think about or conceptualize teaching and learning in the workplace
Increases your self‐awareness by giving feedback to assess thinking and development
Reinforces my positive thinking while calling out my b.s.
Engages in active listening
Describe your current career path. Include company, industry, title and responsibilities.
Are there specific career changes you are currently looking to make?
Describe your formal education.
Describe your family/home situation.
Do you have a supportive sphere of influence?
Do you feel you are ready to begin the commitment required to enter in to a mentor/mentee relationship?
What questions do you have for me?
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm